“If you want to study a human being, do

not pay so much attention to what s/he

says, rather look at the way s/he acts,how s/he comes into a room, how s/he

seats and walks around ……”

Zen Osho Rajneesh

The doctor-patient communication

Is it possibile not to comunicate?

The first principle of communication

pragmatics states that: We cannot avoidcommunication

P. Watzlawick

Let’s reflect on the very act of communication:

• Both in a private and a public structure, any

communication process is basically an exchange

process which can influence the relationships

between collegues, patients and their relatives…

• Both in a private and a public structure, any

communication process is basically an exchange

process which can influence the relationships

between collegues, patients and their relatives…

• Lets’s imagine ourselves while

dealing with our office or ward

head, or with anyone who can

manage the group and replace the

head. …….

• “How can we handle such stream of

communication?”

• Which strategies can we adopt?

• Who are our interlocutors?

• Where can we find appropriate information functional to manage communication?

• When can we choose the right moment for a better handling of this stream?

• How can we valuate the positive ornegative aspects of the relationshipbetween my colleague and me?

• Why do we need to pay particular attention to the process of communication that makes us waste psycho-physical energies?

• Probably we state that the lack of a correct management of communication is related to how and what we communicate. The resulting process of evaluation can have a negative impact on the decisional process, that is we could take harmful decisions both for ourselves and the other(s):patients, colleagues, heads, relatives…

So, let’s ask:what is communication?

• It’s a

• relational process

• an exchange of opinions

• ideas,

• feelings,

• emotions,

• tensions,

• experience,

• perception,

Communication is a process which involves two main instances:

• Content or rationality

• Relation or emotivity

• The former relates to what makes a

message meaningful through words

and sentences .

• of communication like gesturing,

miming, eye-distance...

• If coherence emerges from these

two aspects, we can figure out

whether the message is true and

persuading.

• We must admit that thanks to our

gestures, postures, distance, eyes,

we actually comunicate our

feelings, wishes, beliefs, opinions,

etc..

• let's read now the three levels of communication:

• Technically coomunicating “simply” means:

• “to transfer and receive information”• Basically the transfer of messages is

carried out by three main tools:• VERBAL– content, that is words used to

transfer data and information• PARAVERBAL –form, that is the way we

pronunce words, our tone, volume, rhythm, fastness, pauses

• NON-VERBAL –interpretation, miming, gesturing, postures, eyes.

• When the received concept corresponds

to what has been transmitted we can

state that communication has succeed.

Thus, when our interlocutor fails learning

information and concepts, we are

responsible for this failure.

Communication styles:

1. Passive communication:- aggressive communication- assertive communicationCommunication Typology1. to win/to lose2. to lose/to win

3. to lose/to lose

4. to win/to win

According to your experience, which is theso-called “differential advantage” of

communication?

Listening

Are you able to listen to someone's message?

It is really essential for a doctor to know how tolisten and how to be respondent to the patient’s“load”, that is how s/he describes the problem,her/his emotional experience and interpretations,the emerging dis/advantages, his/her worries,hopes, disappointments; how s/he is emotionallyinvolved in solving her/his pathology; what’sher/his life (origins, education, job, family, home),that is investigating on his/her emotional –affective-bodily-social- "global field".

• Here we have got three main points:

• Passive listening

• Active listening

• Pro-active listening

Passive listeningInterlocutor:

• s/he doesn’t react

• s/he doesn’t make questions

• s/he doesn’t agree

• s/he doesn’t participate

• s/he doesn’t give opinions

Active listening

• The interlocutor:

• reacts

• makes questions

• agrees

• participates

• gives opinions

• wants and receives FEED-BACK

Pro-active listening

• The interlocutor actively participates

to the process of communication

showing empathy and providing

possibile solutions

TEST

Working in pair: perform a communication with a patient of yours who will act as a a) passive, b) active and c) pro-active listener.

• We can say that:

• sharing the map is essential for both verbal and non-verbal communication

• a geographical map can represent a symbolic outline of a determined land as well as a metal map can serve as a perceptive construct of a determined and symbolic reality.

• The geographical mapa helps us to move across a land, whereas the mental map determines the way we interpret experiences and situations.

• Anytime there are two or more interlocutors, two or more comparable mental maps will emerge.

The main problem is to combine whatis simply said with what is reallyacted.

Difficult communication

• Such elements as discussion, content area, thoughts and feelings contribute to the process of communication. This is the area of relations.

• The main problem is to combine what is

simply said with what is really acted.

• What we need is to focus on:

• Objective analysis of “what happened”

• Analysis of feelings (“are my feelings good”?

• Analysis of identity (self-dialogue)

Complex conversations are mainly

based on perceptions, interpretations

and values. Thus, we turn to focus

not on what is true, but on what is

more important for us.

• Communication between doctor and patient:

• Is a therapeutical moment

• Includes a request of technical help

• Is a need of relation

Internal Communication

• This kind of communication concerns

the so-called internal public which

takes place daily with colleagues and

patients

From the doctor-patient communication some obstacles emerge when:

• Is a very important therapeutic time

• Includes a request for technical help

• Is a need to report

la comunicazione medico -

paziente

Barriers between doctor-patient communication arise when:

We are not able to listen to someone else.

• The patient’s disappointment for an unsuccessful communication counts more than the disappointment for the technical skills.

CONCLUSIONS

• when we communicate, we need to

remember that our image is

perceived and "portrayed" by the

listener’s/observer’s senses and

emotions.

SOME USEFUL TIPS:1. The doctor is supposed to be

“neutral”, that is without any prejudices towards the patient who could have got different life styles, attitudes and values (the doctor should pay particolar attention to his/her attitude because his/her main worry must concern the patient's health).

2. To know how to “comunicate” (being collaborative) and to explain to the patient a) the steps of the diagnosis track in few and simple words; b) the meaning of the tests; c) special advice and therapies

10 simple rules to improbe the doctor-patient communication:

• Do not express too many concepts simultaneously

• Speak directly to the patient • Infor also the patient’s relative with

respect to important information• Repeat information several times,

especially id the patient is not well-educated

• Focus on the most important points both at the beginning and at the end of your communication

• Give examples which can help the patient to understand better any matter.

• Sometimes use colloquial or informal expression to acquire more familiarity with the patient

• Give detailed and practical examples of medicines and therapies and make sure that the patient understands every information.

• show positive attitudes and encourage the patient in any diffucult situation. A negative attitude could influence the patient’s view of the therapy.

I wish you could enjoy at least (!) two of theses fruitful tips and use them for your work.

Thanks and have a nice (work) time